# Thoracic Surgery in Children — GCMD Library living collection

Updated: n/a · 6 episodes · 51 cited statements

## Episodes
### Empyema Management
- [Experience with an evidence-based protocol using fibrinolysis as first line treatment for empyema in children](https://library.globalcastmd.com/watch/experience-with-an-evidence-based-protocol-using-fibrinolysis-as-first-line-trea-16116) — article · [machine version](https://library.globalcastmd.com/watch/experience-with-an-evidence-based-protocol-using-fibrinolysis-as-first-line-trea-16116.md)
- [Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial](https://library.globalcastmd.com/watch/thoracoscopic-decortication-vs-tube-thoracostomy-with-fibrinolysis-for-empyema-i-16125) — article · [machine version](https://library.globalcastmd.com/watch/thoracoscopic-decortication-vs-tube-thoracostomy-with-fibrinolysis-for-empyema-i-16125.md)
- [Panel discussion on fibrinolytic therapy versus VATS for pediatric empyema management](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155) — video · 31:34 · [machine version](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155.md)

### Spontaneous Pneumothorax
- [Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation](https://library.globalcastmd.com/watch/changing-the-paradigm-for-management-of-pediatric-primary-spontaneous-pneumothor-16105) — article · [machine version](https://library.globalcastmd.com/watch/changing-the-paradigm-for-management-of-pediatric-primary-spontaneous-pneumothor-16105.md)
- [Spontaneous Pneumothorax](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433) — podcast · 33:31 · [machine version](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433.md)
- [Management of spontaneous pneumothorax in pediatric patients](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154) — podcast · 33:31 · [machine version](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=0) Introduction and Case Presentation (Ep 5)
- [1:40](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=100) Historical Management and Retrospective Data on Chest Tubes (Ep 5)
- [7:24](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=444) Aspiration as Initial Management: Study Design (Ep 5)
- [14:10](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=850) Aspiration Study Results and Predictive Value (Ep 5)
- [20:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1200) Proposed Treatment Algorithm and Family Counseling (Ep 5)
- [22:58](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1378) Surgical Technique and Role of Pleurodesis (Ep 5)
- [27:21](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1641) Management of Recurrent Pneumothorax (Ep 5)
- [28:51](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1731) Special Scenarios and Future Directions (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=0) Introduction and Case Presentation (Ep 6)
- [1:42](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=102) Historical Management and Retrospective Data (Ep 6)
- [5:21](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=321) Aspiration as Initial Treatment (Ep 6)
- [11:09](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=669) Midwest Consortium Prospective Trial Results (Ep 6)
- [20:00](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1200) Current Treatment Algorithm and Family Counseling (Ep 6)
- [23:27](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1407) Pleurodesis Evidence (Ep 6)
- [26:00](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1560) Role of CT Scanning (Ep 6)
- [27:21](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1641) Recurrent Pneumothorax Management (Ep 6)
- [32:46](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1966) Closing Remarks (Ep 6)
- [0:00](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=0) Case presentation and initial management debate for stage 2 empyema (Ep 3)
- [5:30](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=330) Evidence review: fibrinolytic therapy versus VATS for empyema (Ep 3)
- [12:00](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=720) Timing of intervention and imaging modality selection (Ep 3)
- [16:47](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1007) Spontaneous pneumothorax: small pneumothorax management (Ep 3)
- [21:46](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1306) Large pneumothorax and surgical technique debate (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Primary spontaneous pneumothorax is more common in males by approximately 3 to 1. — Dan Ostlie (epidemiological) [Ep 5 · 1:48](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=108)
- In a multi-institutional retrospective study of 81 patients across 3 institutions over 13 years, no patients with primary spontaneous pneumothorax presented with tension physiology. — Dan Ostlie (clinical) [Ep 5 · 11:29](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=689)
- Chest tubes for primary spontaneous pneumothorax work approximately 50% of the time. — Dan Ostlie (clinical) [Ep 5 · 3:45](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=225)
- Patients who receive a chest tube, resolve, and go home have approximately a 50% failure rate (recurrence requiring further intervention). — Dan Ostlie (clinical) [Ep 5 · 5:01](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=301)
- Patients who fail chest tube management in the hospital and subsequently undergo VATS have a recurrence rate of approximately 25-30%. — Dan Ostlie (clinical) [Ep 5 · 5:21](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=321)
- Patients who undergo immediate VATS have a recurrence rate of approximately 10-15%. — Dan Ostlie (clinical) [Ep 5 · 8:02](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=482)
- In the Midwest Consortium prospective study of 33 patients across 9 institutions over 2 years, 50% of patients failed initial aspiration (recurrent pneumothorax within 6 hours). — Dan Ostlie (clinical) [Ep 5 · 14:10](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=850)
- Of 12 patients who failed aspiration and were managed with chest tubes, 83% (approximately 10 patients) ultimately failed chest tube management and required VATS or had recurrent pneumothorax. — Dan Ostlie (clinical) [Ep 5 · 15:33](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=933)
- Of 5 patients who failed aspiration and went directly to VATS, none had recurrence. — Dan Ostlie (clinical) [Ep 5 · 16:39](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=999)
- Of 16 patients who passed the aspiration test and were discharged, 40% (approximately 6-7 patients) returned with recurrent pneumothorax. — Dan Ostlie (clinical) [Ep 5 · 18:40](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1120)
- The positive predictive value of aspiration for successful treatment is 83%, with a negative predictive value of 56%. — Dan Ostlie (clinical) [Ep 5 · 19:07](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1147)
- In the retrospective three-institution study, patients who underwent pleurodesis had the same recurrence rate as those who underwent VATS without pleurodesis. — Dan Ostlie (clinical) [Ep 5 · 23:30](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1410)
- CT scans may identify blebs that are incidental findings and not clinically relevant, similar to traumatic pneumatoceles which rarely rupture. — Dan Ostlie (opinion) [Ep 5 · 26:41](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1601)
- For patients with multiple recurrences after VATS, thoracoscopic pleurectomy (stripping parietal pleura from apex to near-diaphragm) is performed; this is a bloody, painful operation requiring epidural analgesia and hospitalization for a week to 10 days. — Dan Ostlie (clinical) [Ep 5 · 27:45](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1665)
- Aerosolized talc pleurodesis is delivered via a canister with a straw inserted through a trocar site, creating a snow-like appearance in the chest. — Todd Ponsky (clinical) [Ep 5 · 29:00](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1740)
- For a patient with a small (2 cm) apical pneumothorax after previous pleurodesis, if asymptomatic and stable on repeat imaging at 48 hours, observation is appropriate; aspiration carries risk of lung injury and worsening the air leak. — Dan Ostlie (opinion) [Ep 5 · 30:15](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1815)
- Spontaneous pneumothorax is more common in males by approximately 3 to 1. — Dan Ostlie (epidemiological) [Ep 6 · 1:48](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=108)
- In a multi-institutional retrospective study of 81 patients across 3 institutions over 13 years, no patients presented with tension physiology. — Dan Ostlie (clinical) [Ep 6 · 11:29](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=689)
- Chest tube management for spontaneous pneumothorax has approximately 50% failure rate across institutions. — Dan Ostlie (clinical) [Ep 6 · 3:45](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=225)
- Patients who receive chest tube, resolve, and go home have approximately 50% recurrence rate requiring subsequent intervention. — Dan Ostlie (clinical) [Ep 6 · 5:01](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=301)
- Patients who fail chest tube management in hospital and undergo VATS have 25-30% failure rate. — Dan Ostlie (clinical) [Ep 6 · 5:29](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=329)
- Patients who undergo immediate VATS have 10-15% failure rate. — Dan Ostlie (clinical) [Ep 6 · 8:02](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=482)
- CT scan data fairly convincingly shows it is probably not beneficial with regard to changing treatment parameters or outcomes in spontaneous pneumothorax. — Dan Ostlie (clinical) [Ep 6 · 3:05](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=185)
- The Society of Thoracic Surgery in adult patients recommends primary aspiration for spontaneous pneumothorax. — Dan Ostlie (guideline) [Ep 6 · 9:54](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=594)
- In most large studies for primary spontaneous pneumothorax, the mean age is around 20 to 22 years. — Dan Ostlie (epidemiological) [Ep 6 · 10:05](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=605)
- In the Midwest Consortium prospective trial, 33 patients from 9 institutions over 2 years underwent initial aspiration with catheter left in place for 6 hours. — Dan Ostlie (clinical) [Ep 6 · 15:06](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=906)
- Of 33 patients who underwent aspiration, 17 (approximately 50%) failed aspiration with recurrent pneumothorax within 6 hours. — Dan Ostlie (clinical) [Ep 6 · 14:10](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=850)
- Of 12 patients who failed aspiration and received chest tube management, 83% subsequently failed chest tube management requiring VATS or experiencing recurrent pneumothorax. — Dan Ostlie (clinical) [Ep 6 · 15:45](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=945)
- Five patients who failed aspiration went directly to VATS, and none of those recurred. — Dan Ostlie (clinical) [Ep 6 · 16:44](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1004)
- Of 16 patients who passed aspiration and went home, 40% returned with recurrent pneumothorax. — Dan Ostlie (clinical) [Ep 6 · 18:40](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1120)
- The positive predictive value of aspiration for successful treatment is 83%, with negative predictive value of 56%. — Dan Ostlie (clinical) [Ep 6 · 19:07](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1147)
- A large Chinese trial of 289 patients over 3 years, average age 22, randomized patients to wedge resection with or without mechanical pleurodesis and showed identical recurrence rates between groups. — Dan Ostlie (clinical) [Ep 6 · 23:52](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1432)
- In the three-institution retrospective study, patients who underwent pleurodesis had the same recurrence rate as those who underwent VATS without pleurodesis. — Dan Ostlie (clinical) [Ep 6 · 23:37](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1417)
- There is no evidence that pleurodesis for initial operations for spontaneous pneumothorax decreases recurrence rates. — Dan Ostlie (opinion) [Ep 6 · 24:46](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1486)
- CT scans may be overcalling findings that are more common than historically expected and may not be clinically relevant, such as incidental blebs in patients who never develop pneumothorax. — Dan Ostlie (opinion) [Ep 6 · 27:00](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1620)
- For multiply recurrent pneumothorax after failed VATS, thoracoscopic pleurectomy of parietal pleura from apex to several ribs above diaphragm is an option, though it is arduous, bloody, and requires epidural analgesia with hospital stay of 7-10 days. — Dan Ostlie (clinical) [Ep 6 · 27:45](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1665)
- For small apical pneumothorax (2 centimeters) after pleurodesis with fixed lung, observation is preferred over intervention due to risk of injuring lung and creating larger air leak versus minimal physiologic impact of small residual space. — Dan Ostlie (opinion) [Ep 6 · 30:38](https://library.globalcastmd.com/watch/management-of-spontaneous-pneumothorax-in-pediatric-patients-16154?t=1838)
- Stage 2 empyema is defined as loculated pleural effusion with greater than 100,000 white cells — Dan Osley (clinical) [Ep 3 · 3:51](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=231)
- Once empyema is defined with loculations and high white cell count, antibiotics alone are probably not the right choice and intervention is needed to remove fibrinous exudate — Dan Osley (clinical) [Ep 3 · 3:59](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=239)
- The meta-analysis comparing treatment approaches had temporal bias, with VATS cases concentrated in later years, making it an apples-to-oranges comparison — Dan Osley (clinical) [Ep 3 · 6:13](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=373)
- Two independent trials demonstrate fibrinolysis works in 85% of empyema patients — Dan Osley (clinical) [Ep 3 · 8:09](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=489)
- The Kansas City trial used intention-to-treat analysis, so the 6.8-day length of stay includes all patients who failed fibrinolytic therapy and required subsequent VATS (clinical) [Ep 3 · 10:10](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=610)
- In the immediate VATS arm, two children required ECMO and one developed renal failure requiring hemodialysis; these complications did not occur in the fibrinolytic arm (clinical) [Ep 3 · 11:30](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=690)
- Patients remain sick after VATS debridement because of underlying pneumonia, not because of pleural material (clinical) [Ep 3 · 9:08](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=548)
- Ultrasound can sometimes be misleading and show large effusion when disease is actually intraparenchymal necrotic lung that should be treated with antibiotics only (clinical) [Ep 3 · 16:10](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=970)
- Percutaneous Seldinger technique chest tubes can be placed at bedside under local anesthesia with minimal sedation in approximately two minutes and are well tolerated — Dan Osley (clinical) [Ep 3 · 14:05](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=845)
- For spontaneous pneumothorax, there is a 50% failure rate with chest tube alone (clinical) [Ep 3 · 19:26](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1166)
- Teenagers with spontaneous pneumothorax have a characteristic asthenic body habitus with thin chest capacity, and virtually all have blebs in the upper lung — Todd Ponsky (clinical) [Ep 3 · 22:06](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1326)
- Deflating and reinflating the lung during VATS can help identify blebs, particularly on the edges of the lower lobe (clinical) [Ep 3 · 29:00](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1740)
- A combined study of 350 patients who had lung procedures without chest tube placement showed no complications, though these were not spontaneous pneumothorax patients (clinical) [Ep 3 · 29:34](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1774)
- Re-entering a chest that has had talc pleurodesis is extremely difficult and may require retropleural approach — Dan Osley (clinical) [Ep 3 · 30:47](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1847)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The Society of Thoracic Surgery recommends primary aspiration for spontaneous pneumothorax in adult patients. — Dan Ostlie summarizing a resource [Ep 5 · 9:52](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=592)
- In most large studies of primary spontaneous pneumothorax, the mean age is around 20 to 22 years. — Dan Ostlie summarizing a resource [Ep 5 · 10:05](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=605)
- A large randomized trial from China of 289 patients (average age 22) showed no difference in recurrence rates between wedge resection alone versus wedge resection with mechanical pleurodesis using standardized sandpaper abrasion of the parietal pleura. — Dan Ostlie summarizing a resource [Ep 5 · 23:52](https://library.globalcastmd.com/watch/spontaneous-pneumothorax-13433?t=1432)
- A meta-analysis of 170 patients comparing chest tube with fibrinolytic, chest tube with fibrinolytic and delayed thoracoscopy, versus primary VATS showed the primary VATS arm (M3) did better than other approaches — Dan Osley summarizing the discussion [Ep 3 · 5:39](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=339)
- A trial of 60 empyema patients comparing urokinase with small drain, saline with small drain, urokinase with large drain, and saline with large drain (no operations) showed small tube with urokinase performed best — Dan Osley summarizing the discussion [Ep 3 · 6:31](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=391)
- The London trial using urokinase showed length of stay 6 days, cost £13,000 versus £11,300, and 16% failure rate — Dan Osley summarizing the discussion [Ep 3 · 7:19](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=439)
- The Kansas City trial using TPA showed length of stay 6.8 days in both arms, cost $11,600 versus $11,300 and $7,500 versus $9,000, and 15% failure rate — Dan Osley summarizing the discussion [Ep 3 · 7:53](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=473)
- A Cochrane review with one randomized controlled trial (including patients age 16 and up) showed simple aspiration had 59% immediate success rate for pneumothorax, equivalent to chest tube outcomes — The host summarizing the discussion [Ep 3 · 20:19](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1219)
- In the aspiration trial, 11 patients failed aspiration, 9 received chest tubes, only 2 required VATS, and 50% avoided hospitalization with no difference in overall hospital stay or recurrence rate — The host summarizing the discussion [Ep 3 · 20:38](https://library.globalcastmd.com/watch/panel-discussion-on-fibrinolytic-therapy-versus-vats-for-pediatric-empyema-manag-16155?t=1238)

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